The association between self-rated health and underlying biomarker levels is modified by age, gender, and household income: Evidence from Understanding Society - The UK Household Longitudinal Study.

M.Pia Chaparro,Michaela Benzeval,Meena Kumari,Amanda Hughes

doi:10.1016/j.ssmph.2019.100406

M.Pia Chaparro, Michaela Benzeval + Show 2 more

Open Access

https://doi.org/10.1016/j.ssmph.2019.100406

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Abstract

The goal of this study was to evaluate how self-rated health (SRH) and objective measures of health (biomarkers) are associated, and if this association varies by gender, age, and socioeconomic position (measured by household income). Data come from the UK Household Longitudinal Study nurse visit (2010–2012), including a representative sample of adults in Great Britain (N = 15 687 maximum sample). SRH was assessed by the question “In general, would you say your health is excellent, very good, good, fair, or poor?” and dichotomized into good or poor. Indices were created for four biomarker categories based on the aspects of health they are likely to reflect, including visible weigh-related, fitness, fatigue, and disease risk biomarkers. Logistic regression models were run with SRH as the outcome and each biomarker index as a predictor, adjusting by gender, age, and income. Further, interaction terms between each biomarker index and gender, age, and income (independently) were added to test for effect modification. All biomarker indices were associated with SRH in expected directions, with the fitness index most strongly predicting SRH. Gender, age, or income modified the associations between SRH and all biomarker indices to different extents. The association between the visible weight-related biomarker index (including body mass/fat variables) and SRH was stronger for women than men and for those in higher income groups than lower income groups. Income also modified the association between SRH and the fitness biomarker index, whereas age modified the association between SRH and the fatigue biomarker index. When using SRH to investigate health inequalities, researchers and policy makers should be clear that different social groups may systematically consider different dimensions of health when reporting their SRH.

Highlights

Self-rated health (SRH) is the most widely used proxy for health status in medical sociology research (Jylhä, 2009)
Using data from Understanding Society – the UK Household Longitudinal Study (UKHLS), the objectives of this study were to: 1) evaluate how responses to self-rated health (SRH) vary by underlying biomarker levels, and 2) evaluate if the association between SRH and biomarkers is modified by age, gender, and socioeconomic position (SEP)
We found that all the biomarker group indices were negatively associated with SRH, with higher indices associated with lower odds of reporting good health

Summary

Introduction

Self-rated health (SRH) is the most widely used proxy for health status in medical sociology research (Jylhä, 2009). When asked to rate their own health, a person begins by assessing health as a concept: what does it mean for them and which health components are most relevant to them (Jylhä, 2009) This conceptualization is influenced by contextual and cultural factors, including the individual's demographic and social characteristics. It is expected that people's responses to the SRH question will vary by age, gender, and SEP, and by cohort, culture, and social networks Given these complexities, Jylhä (2009) argues that SRH should be understood as both a subjective and contextual self-assessment, and as an indicator of somatic and mental state

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